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Interesting discussion and articles on Republicans Greg, Cesar, and Fred. A key point missing is the role of women in reforming the Republican party, expanding its membership, and recasting its brand so that it more accurately reflects the true diversity of people and viewpoints that are within it.

See Kathleen Parker’s recent Washington Post article, Time for the GOP Women .She writes, “If the GOP is really serious about expanding the party, it's time for the men to hush and let the pros take over. As the saying goes: If you need something done, hire a busy woman. Or, as the White House Project puts it: ‘Add women, change everything.’

In Virginia, Bob McDonnell is giving women a greater voice. One of the most persuasive, impressive, and powerful advocates for Mr. McDonnell is an African-American businesswoman, Sheila Johnson, who, ironically, is a Democrat.

Ms. Johnson is the co-founder of Black Entertainment Television, and leads an impressive portfolio of businesses. Like the majority of small business owners in the US who are women, she understands what it means to make payroll, to create jobs, value and opportunities, to pay taxes, to navigate an array of regulations and challenges and to overcome a variety obstacles.

Mr. McDonnell has invited Ms. Johnson to travel the state with him, sharing the stage and spotlight with her.

At a bi-partisan luncheon for women recently, Ms. Johnson explained why as a Democrat, she is supporting Mr. McDonnell, a Republican. After lengthy interviews with all of the candidates (including three Democrats prior to the primary), the only one that really understood how public policy should support economic development and job creation was Bob McDonnell.

As she travels the state, Johnson’s message is one about empowering women – advising women to vote for candidates who support their economic development, self-determination, and their role as leaders and protectors within their families. She stressed that political parties have got it wrong – that when it comes to women, they focus on just one issue (implying Pro-Choice or Pro-Life), and that women shouldn’t choose a party or a candidate on one issue, but rather on those issues that open up opportunities for them to achieve their potential.

Ms. Johnson’s message resonates. With McDonnell, she reaches out to a diverse group of women – Independents, Democrats, Republicans, business leaders, small business owners, teachers, mothers, grandmothers, and more.

I believe Ms. Johnson’s endorsement of Mr. McDonnell is an indicator of things to come for the Republican party if it embraces policies of free enterprise, of "keeping taxes, litigation, and regulation low.”

There are other encouraging signs that Virginia’s Republican party is adjusting to demographic changes. For example, in the House of Delegates race, the candidates of Northern Virginia are a diverse group – Barbara Comstock is a small business owner, Sasha Gong, an immigrant from China who came to the US with $20 (and who, incidentally, left the Democrat party to become a Republican recently), and Vickie Vasquez, a Native American.

I would say to Greg, change is underway; polls and brands are fickle.

The Republican party is learning from its shortcomings, new candidates represent a better reflection of who the party really is, and women are key to the party’s future.

So the public option is back. The headline atop Dan Balz’s story in The Washington Post this morning blares, “New life for the public option.”

But why? Why was the public option (TPO), as Balz puts it, “on life support” just a little while ago, and yet now TPO is up and walking around? Balz’s answer is two-fold; first, there was a backlash against the insurance companies, and second, TPO was rising in the polls, even as the pundits were saying TPO’s last rites. I won’t argue with Balz, a thoughtful and fair-minded reporter, but I think that we can look back and identify, with precision, a more specific “tipping point” in this latest phase of the healthcare debate. A tipping point that speaks volumes about the current political situation, and about larger cycles of popular passion.

That tipping point, in my reckoning, was Rep. Alan Grayson’s September 29 speech from the floor of the House, in which the Florida Democrat declared that the Republican healthcare plan could be summed up as “Don't get sick, and if you do get sick...die quickly.”

So, Grayson says, Republicans want to kill innocent people. Now that was a message that punched through. Because of those words, Grayson instantly rose from freshman obscurity, into (your choice) glory or ignominy. Grayson didn’t apologize, indeed, he used his newfound prominence to light a pro-TPO fire under senior Democrats; on October 14, he personally delivered a strongly worded pro-PTO petition to a fellow Democrat, Senate Majority Leader Harry Reid. “It’s so urgent that we move ahead,” Grayson told Politico. “The cost of delay is death.”

So there it is again, the “d-word”--death. Freud argued that all of life is an endless tug-of-war between eros and thanatos, between love and death. And so it follows that if you want to make a powerful argument, you tap into one or both of those two main cables of human thinking. Grayson chose death. And it worked. A killer argument, one might say.

So Grayson provided a vivid bookend to the other super-powerful utilization of the “d-word,” which had earlier been used by one of Grayson’s, uh, mortal enemies. And that enemy, of course, is former Alaska governor Sarah Palin, who launched the phrase “death panels” from her Facebook page on August 7. Palin’s use of the “d-word” was similarly electric last summer; within days of her posting, Democrats specifically kiboshed hitherto uncontroversial “end of life counseling” provisions in their healthcare bill.

And yet even so, support for the overall idea of Obamacare fell in the wake of Palin’s attack. Dark visions of death loomed larger in people’s minds than once-bright thoughts of “hope.” And as we have seen, when pro-TPO Democrats made their recent resurgence, it was powered by a death-vision of their own, courtesy of Grayson. Hope had nothing to do with it.

Thus dueling visions of death, Grayson’s and Palin’s, have hardened the two parties’ positions, further polarizing the healthcare debate--it's entirely possible that nothing can be enacted in this environment. So in a sense, this “death match” is of a piece with other polarizing forces in our politics and media.

And there’s also a larger politics lesson here, bubbling up from our collective ids. Wonky policy talk is the natural language of technocrats and experts who must communicate with each other, even across the partisan divide. Moreover, most of the wonks, on both sides of the aisle, are middle- and upper-middle-class strivers. They have been to the same schools, or at least read the same textbooks--whether or not they agreed with what was in them. They are, in the best sense of the word, professionals.

Yet to impassioned outsiders, such wonk-talk is brittle, even sterile, disconnected as it is from the wellsprings of faith and belief. To a Grayson or a Palin, to a Michelle Bachmann or a Dennis Kucinich, fluent professionalism often sounds like opportunism and cynicism, language that obscures more than it reveals. And so, outside the beltway, a new insurgency is always brewing, an attack of mistrustful outsider peripherals on the mistrusted insider core.

So one’s thoughts go back to the Enlightenment of the 18th century. Across the Western world, in the age of Johnson and Diderot, of Catherine the Great and Frederick the Great, elites and intellectuals agreed on a certain amount of secular and scientific progress--or thought they did. And then came Romanticism, in which poets and peoples rejected the baroque edifices of “the establishment” and embraced, instead, fervor and even mysticism. The result in the 19th century was, as someone put it, better art, and worse politics.

Now back to the present day. Like every other aspect of human nature, politics is ultimately driven by visionaries, by those who lead by revelation, from the heart, not the head. As George Bernard Shaw observed, “The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.” Unfortunately, it is not known if Shaw also said, “All regress, too, depends on the unreasonable man--and woman.”

There will come a day when passions cool, when men and women can come together, and reason together. When consensus can be reached and compromise can be forged. But it is obviously not to be this day--or any day soon.

We hear a great deal about supporting our troops, and there's nothing wrong about that. But on this open mic Sunday I'd like to urge folks to do something else as well: support our diplomats.

American diplomats don't get nearly the credit they deserve. Historically, we've never had much regard for our diplomatic corps: Richard Nixon referred to the State Department as "Dean Acheson's Cowardly College of Communist Appeasement" and denounced the striped-pants pinkos and cookie-pushers who were giving away the store to our enemies. He wasn't alone.

Over the years I've visited dozens of US embassies around the world and met hundreds of diplomats. Especially during the last eight years, being a US diplomat was both a difficult and a dangerous assignment in much of the world. The patriotism, dignity, professionalism and courage that our diplomats displayed in those years is one of the untold stories in American life. We have a lot of unsung heroes out there, working hard on difficult assignments and usually struggling with a critical lack of resources. In places like Baghdad, Islamabad and Beirut, to be a US diplomat is to be, literally, a target for assassins night and day.

I hope Arena readers will take a couple of moments today to reflect on the kind of courage and patriotism it takes to serve in the State Department today and think about what each of us can do to show our support and appreciation for an extraordinary group of people.

A hardy perennial of health policy mythology is the story of the accidental health care system. It appears again in an editorial in the Post this morning and was heard also on NPR this week.

The story is that our employment-based health insurance system is a complete accident (and impliedly, a complete mistake). Employment-based health insurance originated in the United States, according to this story, because fringe benefits were exempted from wage and price controls by the War Labor Board during World War II and employers, eager to find workers in a tight labor market, started offering health insurance. The addition of exclusions and deductions for employee health benefits in the 1954 Internal Revenue Code cemented employment-based health insurance in place and left us in the mess we are today. It had nothing to do with what Americans wanted, only bad federal tax policy.

Great story. Not true. If you want the details, read my book Health Care at Risk: A Critique of Consumer-Driven Movement (Duke 2007). The short version is this. Health insurance began during the Depression, not the War, and was driven by hospitals trying to find a way to stay in business by getting people to prepay for health care (a fact the NPR report acknowledges).

The new Blue Cross plans signed up employment-based groups as a way to avoid the adverse selection problem that had blocked commercial health insurance previously. Employment-based groups were natural groups, formed for a reason other than buying health insurance, and were relatively healthy. Signing them up also saved administrative costs, as employees could be enrolled through their employers, who would also make sure that premiums were paid. Initially, employers did not contribute to the premiums; they simply took the premiums out of the employee’s wages. Employment-based insurance was already well established by the War.

There were wage and price controls during the War, and benefits were to some extent excepted, but most of the growth in health insurance during the War took place before they went into effect, and, in any event, most employers were still not paying premiums, so it made no difference.

The explosive growth in employment-based insurance took place after the War, but before the tax code was changed. It was driven by the unions who were at the height of their strength in the late 1940s and early 1950s. Employees wanted health care, and the unions got it for them, or employers offered it to employees preemptively to avoid unionization. Commercial insurers were now in the business, but they also wanted employment-based groups, not individual insureds who only signed up once they were sick.

The tax deduction undoubtedly has contributed to the generosity and scope of employment-based health insurance, but it did not cause it. Neither would employment-based insurance go away if we eliminated the deduction tomorrow. Eliminating the deduction, moreover, would constitute the largest peace-time tax increase in American history. Replacing it with tax credits would not only greatly increase administrative costs, it would call for a massive bureaucracy to determine who was entitled to what credits and to pass these on to the insurance companies in premiums. The size of the exchanges and of the tax credit program included in proposed legislation would have to be increased five or six fold.

Should we get rid of employment-based health insurance? It cannot possibly cover everyone and does contribute to job lock and distortions in health insurance coverage. In fact many European countries began with employment-based insurance, but went on from it to universal coverage, often, as in Germany, by merely expanding the job-based social insurance system. This is a route we could go, but do not seem likely to go right now.

Should we cap the tax deduction? Perhaps, but let’s think about this. People who pay for high cost insurance often live in high cost areas, or belong to groups that are disproportionately sick or older, or have lower cost sharing and thus better access to health care. Do we really want to fund health insurance expansion by taxing the sick or those who happen to live in high cost areas?

We could limit the tax to those who receive high cost health insurance because of generous compensation packages, but then why not just tax the generous compensation?

The Post editorial dismisses taxes on high income Americans out of hand, as if the proposal did not merit serious discussion. But why not? The upper 1% of Americans earn a quarter of national income and right now are enjoying historically low income tax rates. They are the only group of Americans whose income has grown in the past decade, and many of them have benefited massively from federal bail-outs in the recent past. Why not ask them to pay their fair share to hold down the deficit? Does anyone believe they will be less productive (if indeed they are productive now) if their tax rates go up a few percentage points. Why would we rather tax the benefits of older and sicker Americans who happen to have adequate health care coverage?

We are in the midst of an important discussion here. Let’s base it on facts and logic, not myths.

There has been much speculation about whether it will be advantageous politically for the Obama Administration to attempt to define Fox news as not a legitimate news organization.

I'd like to offer a different perspective of what is going on.

American journalism is in the middle of a great transition. Older models of journalism based on local newspaper monopolies and a small number of broadcast news sources have given way to a wide abundance of sources for journalism. This has occurred over the last thirty years; the Internet is the most salient cause, but in fact, as Fox News and Rush Limbaugh demonstrate, the prime movers were cable television and talk radio, respectively.

Telecommunications regulation imposed a fairness doctrine that mapped on to professional journalistic models of objectivity well into the 1980s. After its repeal, talk radio and Fox news became possible. Local newspaper monopolies, which were connected to control over classified advertising cause newspapers to maintain a version of journalistic objectivity even without a fairness doctrine.

In the current age, however, newspapers are in financial crisis, and talk radio and Fox News are ascendant. Models of journalism change with changes in the economic and social conditions that produce them; conceptions of professionalism and the social obligations of the media, in turn, develop alongside and in conversation with these transformations.

We have been witnessing the return of a twenty-first century version of the party presses of the late 18th and 19th centuries. These party presses have no obligation to be journalistically objective, and they are not. They may say, as Fox News does, that they separate out news coverage from editorial writing, as the Wall Street Journal has done for many years. But do not believe it. Fox News is not the Wall Street Journal (or at least, the pre-Murdoch owned Wall Street Journal). It is a party press, and its editorial coverage affects its news coverage, which should be obvious to anyone who watches it for even an hour or so.

This new form of journalism is not, strictly speaking, a "party press" in the early 19th century mold because it is not owned and operated directly or indirectly by a political party. It is, however, a "partisan press," because it is unabashedly partisan in its purposes and its product, including both editorial and news operations. Indeed the two operations increasingly merge in the new partisan press, as they did in the nineteenth century party press. (Fox's protestations that it keeps these two elements of its product rigidly separate cannot really be taken seriously. But these protestations have served an important function. It is how Fox initially introduced itself and legitimated itself within a world dominated by an older conception of journalism and existing professional standards.).

The new party press seeks to have it both ways: to be a party press and to participate in institutions that were designed for a mid-twentieth century version of so-called "objective" or middle of the road journalism. It seeks both to define news and to influence legacy journalistic organizations. As we have seen in recent comments by editors from the New York Times and the Washington Post about how it is important to pay attention to stories being developed by Fox News, the new party press has succeeded in this endeavor. It is driving news coverage ideologically while being able to say with a straight face that is just the same as legacy media that seek to maintain the mid-twentieth century model.

Moreover, several traditional news organizations, interpreting the Obama Administration's response to Fox News as an attack on journalism generally, including mid-twentieth century models, have come to the defense of Fox. This is especially ironic given that Fox represents a new partisan model that is attempting to displace and destroy their cherished model of "objective" journalism. Because traditional journalistic organizations have understood the Administration's push back against Fox an attack on journalism generally, and not as an attack on the newly emerging partisan press, these organizations, by rising to the defense of Fox News are helping to dig their own graves. Why, after all, should an organization like Fox have any incentive to be fair or objective when the Washington Post and the New York Times will fight to the death to preserve Fox's equal right to the special privileges enjoyed by traditional mass media organizations and their special access to politicians?

The issue we face today is how American Presidents will adapt to the rise of the new partisan press. Generally speaking, American Presidents, and politicians more generally, adapt to whatever forms of journalism surround them, trying to use them to their own advantage. The Bush Administration did not face particular difficulties in dealing with Fox News and talk radio, because these media were allies of the Republican Party and the conservative movement. Moreover, the Bush Administration had no incentives to recognize the new media as a new form of party press. Indeed, its incentives were to emphasize that Fox News was fair and balanced. The Clinton Administration did have incentives, this was earlier in the transformation of the media and the Administration had not really figured out the transformation and how to adapt to it.

Barack Obama's Administration is the first Administration that both faces a dominant and hostile new party press and has publicly recognized it as such. It is seeking to change politicians' (and Presidents') relationships to a media that has already changed for better or for worse. It is the first Presidency to recognize and adapt to the rise of a powerful party/partisan press, which, if the current decline of traditional newspapers continues, is likely to be an increasingly dominant form of journalism in this century.

Whether the Obama Administration's current strategy will be successful, it is clearly correct for it to identify and name the changed conditions under which future Presidents will have to operate.

The irony of the Administration's response to Fox News is its declaration that Fox is not a "legitimate" news organization. It is not a legitimate mid-twentieth century news organization. But it is a legitimate nineteenth century news organization and it could well be what twenty-first century news organizations increasingly look like. The concept of "legitimacy" in news gathering and reporting is not timeless and forever fixed; the point is that it is now very much up for grabs. What the Obama Administration is trading on in its attacks is the notion that "legitimate" journalism is "objective" twentieth century journalism, and since Fox is not that, it is not legitimate journalism. Fox, for its part, actually plays into this framing because it insists that it is fair and balanced and objective, when it is anything but. Fox has been trying to have it both ways since it began; the Obama Administration is now calling its bluff, and attempting to redefine it as not legitimate according to a previous (but increasingly challenged) conception of legitimate journalism.

In the long run, it will probably be better for the Administration and future Administrations not to say that Fox and its successors are not "legitimate" journalists, but that they are not actually objective journalists; instead they are members of a new party or partisan press. That model of the press may be legitimate in the twenty-first century, but politicians have no obligation to treat it as they treated an earlier model of journalism.

In deciding how to move forward in Afghanistan, Obama faces few good choices. And each of them will be accompanied by difficult repercussions on the domestic front--in part due to the particular challenges faced by Democratic presidents on foreign policy issues. Over at the New Republic, my NYU colleague (and fellow Arena "Player") Joshua Tucker and I offer some recommendations to Obama on how to navigate the treacherous shoals of public opinion on Afghanistan. Our advice: have no illusions that you can change public opinion on the issue; frame whatever decision you make as guided solely by U.S. national security concerns (rather than, say, nation-building); and if possible, explicitly invoke the model of the Iraq surge in describing what we're doing there (escalate, stabilize, draw-down). If Obama takes all of these precautions, he just might contain the political fallout from a painful foreign policy choice.

Jim VandeHei and Mike Allen's recent story in POLITICO about angry tone of conservative activists and media personalities wounding the GOP is a bit exaggerated, I think. Making the case against big deficits and Washington overspending not only energizes the conservative base, but appeals to fiscally-conservative independent voters as well. However, when Congress takes up immigration reform next year, I do fear that Republicans could be wounded politically by the anti-immigrant voices in the conservative base.

Immigration reform divides Republicans -- on one side is the business community and conservative opinon leaders, and on the other side is the small but vocal anti-immigrant strain of the GOP (which is mirrored by the extreme population control zealots in the liberal Democratic base), which threatens to alienate hispanics and other minorities, even those who share their opposition to legalization and citizenship for undocumented aliens.

Republicans need Hispanics, Asians and other minorities in order to be politically competitive, especially at the Presidential level. During the debate over immigration reform, Republicans must be mindful of their tone. Even those opposed to immigration reform should celebrate America's heritage as a "nation of immigrants" and what Ronald Reagan called the "shining city on a hill." Most important of all, Republican leaders must show the courage to rebuke the angry anti-immigrant voices on the right.

Cesar, that's an excellent comment and you rightly note the problem. Also, it is worth mentioning non-politicians and non-party people with platforms (Lou Dobbs comes to mind, but there are others) that do this country a disservice by raising the rhetoric on immigration to the point where rational discussion is made more difficult. The need to approach the issue rationally does not go away just because others don't talk about it, or cede the stage to the louder voices. In addition, this remains an important area for bipartisan cooperation. Let's not see it go the way of health reform.

Digging Up An Unexploded Bomb: New Polls On The Public Option Don't Change Its Three Unresolved Problems

For all of manufactured shrieks at the zombie-like resurrection of a public option, nothing has happened legislatively to address its three fundamental problems. The Democratic leadership's lack of attention to them reveals even more reasons why everyone else should be worried. In the days following the recent poll-induced rapture, the editorial boards of various national newspapers, including the Washington Post, have highlighted one or more of these issues. Here they are:

1. Using Taxpayer Subsidies to Kill Off Private Competition

Honest business competition occurs over three factors: management, product and price. The first one, management, is almost always a fair fight, with brilliant winners and frustrated losers. The second, product, is skewed only when government impose a product standard (e.g., minimum benefits, minimum percentage of payroll, and maximum co-pays -- just read the Baucus bill) that gives itself an advantage while also limiting consumer choice. And then there's price: proponents of the public option have yet to respond to criticism that the price of a policy offered by a public option will be heavily subsidized by taxpayers, other than to simply say it won't be.

As currently constructed in the House bills, a government insurer would pay no corporate taxes and no taxes on dividends, pay none of the normal risk or tax premium on its capitalization, effectively enjoy the full faith and credit of the federal government (if you liked the AIG bailout, watch this one), have the non-salary costs of its employees embedded in the umbrella federal personnel structure, and enjoy instant, national economies of scale that make marketing a mere footnote in its annual report and that are currently unavailable to private insurers due to state-by-state regulation. Those are subsidies with a real cost to taxpayers. Add them all up and they would convey to the public option a cost advantage of 30 percent or more, overwhelming even the most efficient entity lacking those artificial supports.

It's important to note that none of these costs -- direct, indirect, tax losses and risk premiums -- are included in the price tag of any bill that offers a public option. That's a big problem of its own, but it is the inevitable competitive effect of such subsidies that should be broadcast to all Americans: an unrestrained single payer monopoly.

2. Substituting Income Taxes for Premiums and Co-Pay

It is an unstated objective of the public option's proponents to have as much health care paid as possible paid for through the progressive income tax rather than through premiums and co-pays; that is, with almost everyone but the upper middle class and above subsidized in some way by the government, the unit price of health care services for everyone would be effectively means-tested, like food stamps and Pell grants, but also like traffic fines in Finland, where a routine speeding ticket can cost you six figures if you had an otherwise good year. This is roughly what we already have for Medicaid recipients and lower-income Medicare clients, and it's fair as far as it now goes. However, the pending bills in Congress have so little faith that they will contain medical costs that they include direct insurance subsidies all the way through nearly the entire range of the middle class. Moreover, the insurer-level subsidies mentioned in Item #1 extend the price-value distortion into all the way up the income range.

The problem with all of this is not with poor people getting the help they need, as they should, but rather the perverse effects that arise when the price paid for a service is disconnected from its true cost. No rational economic decisions--the kind that normally force innovation and limit aggregate cost growth--can be expected when routine personal services (as opposed to common services, like national defense) are being bought with ten-cent dollars by some and hundred-dollar dollars by someone else.

3. Entitlement-like Absence of Restraint

By now all Americans should be familiar with the fiscal story of Medicare: abject failure to adhere to program cost projections and disbursement guidelines established at each renewal or expansion. The only cost projection in its entire history that turned out to be correct was for Bush's Medicare drug benefit, mostly because of the intense competition it fostered among numerous private entities functioning in a national (as opposed to state-by-state) market for a finite range of insurance and drug products, all of which have a high degree of consumer price/value knowledge and sensitivity.

Subsidies are addictive, politically and economically, and so will be a subsidized public option. Over time they become a force nearly impossible to reverse, as every government that has ever provided them can attest: water in Brazil, gasoline in Iran, sugar in the United States. The notion that artificially cheapened insurance -- especially where the cost of the subsidy is mostly borne by someone other than the beneficiaries -- can every be re-priced at market levels once the consequences become too unbearable is sheer fantasy. Again, witness Medicare or Social Security.

It's Time for Truth on Consequences

Congressional proponents of the public option know all of this, just as they should know that the subsidies I've discussed must eventually drive out financially self-contained private competitors and result in a single payer system. They know that once the monopoly is in place and the day of fiscal reckoning arrives, there must be corrections, just as we will ultimately raise the retirement age for Social Security, limit benefits to the next cohort of retiring workers and, in the case of Medicare and a single payer system, eventually introduce Canadian-style waiting times ("Russian inflation") and other limitations on of the range of services. It is a price the Democratic leadership thinks we should be willing to pay for universal coverage, as though there were no other alternatives for achieving it, but isn't it time they come clean about the consequences and ask the American people if they would still agree?

* More than 1000 Americans have died from swine flu, and worldwide, swine flu deaths near 5000. Meanwhile, the headline in yesterday's New York Times painted a somewhat disconcerting picture: "Shortages and Confusion in Flu Fight." But of course, skeptics abound, from Bill Maher on the left (sort of) to Glenn Beck on the right (sort of). So in the midst of this muddle, what's the right public-health strategy?

One answer, as we shall see, comes from the history of technology, which can eventually be made to work. With enough patience and persistence, even the greatest national endeavors can succeed.

But first, we should pause over the good news about swine flu, starting with the fact that we have the vaccine at all. Thanks to improved science, including the decrypting of the human genome, we have dramatically accelerated the vaccine-making process, getting done in weeks that which used to take months--and, of course, couldn't have been done at all just a few decades ago.

But of course, that doesn't explain away all the SNAFUs. And some have leapt to make their case that governmental incompetence is endemic, even about epidemics. "Life Under Obamacare?"--that was the acerbic headline of a pungent editorial in yesterday's The New York Post:

Many say that's what Americans will face if the government runs the nation's health-care system, as Democrats in Washington propose. And that suggestion is certainly gaining credibility, based on the way Washington is handling today's flu-vaccine program. ...

If federal bureaucrats can't handle this program -- despite having warned about it since last spring -- how on earth will they manage a trillion-dollar comprehensive health-care system, if Congress enacts ObamaCare?

Here at Serious Medicine Strategy, we won't defend everything that the Obama administration has done on the swine flu issue; on "Fox News Watch" today, I noted that the White House seems more interested in attacking its enemies than attacking public health problems. It would, in fact, be nice to see the President spending as much time on the health of Americans as he is spending on Afghanistan, or cap-and-trade, or other issues with considerably less impact on American lives. Yes, it was nice that the President last night declared swine flu to be a national emergency, bu we might review the first nine months of his presidency and fairly ask of the President: Swine flu ranks exactly where on your list of priorities?

Still, here at SMS caution against the tempting conflation between public health efforts (almost all of which carried out by professionals, whether or not the commander-in-chief shows any interest) and the push for national health insurance (almost all of which is being carried out by politicians, pundits, and ideologues). Despite the bad name that "national health" is giving to "public health," we tend to think that the government, working with private industry, and all the various stakeholders, should be doing more, not less. We should seek to power through the problem, as part of our overall Serious Medicine Strategy.

Those thoughts were underscored for me as I was reading Antony Beevor'snew book,D-Day: The Battle For Normandy, specifically, the chapter on the American assault on Omaha Beach, memorialized so harrowingly and dramatically in the 1998 movie, "Saving Private Ryan." Those portions from Beevor's excellent book remind us that every technology is usually in a process of improvement--much needed improvement. A case in point is aerial bombing.

As Beevor describes it in his book, 329 American heavy bombers flew over Omaha beach in advance of the amphibious assault, dropping 13,000 bombs. And what was the damage done to the German targets? Zero. That's right, none of the bombs hit the beach defenses. As one observer said of the failed bombardment of the Germans, "That's a fat lot of use--all it's done is wake them up."

Beevor summarizes: "The US Army Air Corps had made wildly optimistic claims about their 'precision bombing.'" Gens. Bernard Montgomery and Omar Bradley "seemed oblivious to the fact that the heavy bombing formations remained incapable of dropping the majority of their load within a five-mile radius of their target."

The Normandy campaign abounded with such tragic mistakes--hundreds, if not thousands, of Allied soldiers were killed in "friendly fire" incidents, including Gen. George Patton's right-hand man, Lt. Gen. Lesley McNair. And much of the air power in the whole war was wasted, on one bad plan or another. But that's the nature of war: Like anything else, it takes experimentation to figure out what works and what doesn't work. And that experimentation, bloody as it might be, is the only way to do it--you can do a lot in a laboratory, but for those inventions to do their job, they have to be introduced into the battlefield.

And of course, air power was probably the single most effective and decisive weapon in World War Two, especially if one includes the B-29-dropped atomic bomb as part of air power. But still, the fact remains that airpower over-promised and under-delivered on so many occasions during World War Two--and in just about every war in the last 90 years. Most notoriously, the perceived failure of air power to change the course of the Vietnam War haunts American policymakers to this day. (There is a substantial school of thought that holds that the US could have won in Vietnam by dropping more bombs, on top targets, as we did in the "Christmas Bombing" of 1972, but of course, we'll never know.)

But by now, after decades of relentless efforts at improvement, and billions or even trillions of expenditure, we have gotten to the fact that we can drop a bomb--or a cruise missile--onto just about any target anywhere, with precision accuracy that is really precise. As we have discovered, such precision doesn't guarantee that we can kill, say, Osama Bin Laden, because he's a moving target, but if we knew exactly where he was, we could blow him up within minutes. And that's quite an achievement--a reminder that if we try hard enough, we can solve these problems.

And so back to public health. If we can precision-strike military targets, we can also precision-strike medical targets. And most Americans would probably be glad to see us try just as hard on medical targets as we do on military targets.

Not a great week or a bad week for Democrats, but a lousy week for Republicans. The noise makers on the right at Fox were going off the wall because the White House attacked them. Palin vs. McCain with regard to the Congressional election in upstate New York. The leading Republican questioning the ethics of Charlie Rangle has his own $300,000 ethics issue. New poll numbers show only 1 in 5 Americans (20%) identify themselves as Republicans. It goes on, and on and on. The best thing going for the Democrats is the Republican Party!!!

AP: President Barack Obama has declared the swine flu outbreak a national emergency.

The White House on Saturday said Obama signed a proclamation that would allow medical officials to bypass certain federal requirements. Officials described the move as similar to a declaration ahead of a hurricane making landfall. Swine flu is more widespread now than it's ever been and has resulted in more than 1,000 U.S. deaths so far.

Health authorities say almost 100 children have died from the flu, known as H1N1, and 46 states now have widespread flu activity. The White House said Obama signed the declaration on Friday evening.

Amitai EtzioniUniversity Professor and Professor of International Affairs, GW University :

The deficit trap

The Obama administration is planning to soon start to cut the deficit for economic and political reasons. To now even merely discuss the tax raises, expenditure cuts, and increases in internet rates that are entailed-- will slow the recovery. We know what must be done; it does not require long preparations. And there is no sign that the feared inflation that deficits are said to cause is anywhere in sight. True, once inflation settles in, it is difficult to eliminate —but it starts slowly. There is plenty of time.

Note that both Carter and Clinton fought to balance the budget and cut or capped social programs—only to allow the Republican administrations that followed to provide huge tax cuts to those better-off.

As to politics—whatever Obama does, the GOP will complain that the deficit is too high and make political hay out of the tax raises and benefit cuts. As to the voters—while they tell pollsters they fear deficits, they hate increased taxes and benefit cuts many times more.

Last but not least, how much deficit is bad for the economy is far from clear.

In short, for now, worry about those without jobs, not those who are crying about deficits.

I live in New York City, where we are having a mayoral election. At the moment, it seems as though democracy has been suspended. Our mayor has spent $85 million so far in his pursuit of a third term, and the New York Times reports today that he will end up spending more than $100 million, possibly as much as $140 million.

His opponent, William Thompson, the city's comptroller, does not have the mayor's private wealth, so his spending depends on public financing. I forget what he has to spend, but it is something like $6-8 million. Chump change.

During this campaign, the mayor had the unmitigated gall to put out a proposal for campaign finance reform. Sorry to say, I didn't read it. What was the point? I assume he proposed to put additional restrictions on people giving and getting money, but not on self-financed candidates like himself.

As it happens, I like and admire Mayor Bloomberg. But there is something fundamentally undemocratic about his ability to spend money in so lavish a fashion: first, to "persuade" the City Council to overturn term limits, which voters had twice approved in referenda; then, to swamp his opponent.

I

n the pantheon of loathsome behavior, there are two standouts: One, the New York Times, which regularly nags the world about the importance of campaign finance reform, yet today gave its editorial support to the mayor, who has demonstrated total contempt for such reform. Two, Howard Wolfson and similar flacks, who regularly step up to defend the mayor's blithe dismissal of term limits and his obscene spending by saying "he is giving voters a choice."

Do voters have a choice when one candidate spends $140 million and the other spends $7 million?

According to CNN , “The Republican Party's favorable rating among Americans is at lowest level in at least a decade, according to a new national poll. Thirty-six percent of people questioned in a CNN/Opinion Research Corporation survey released Friday say they have a favorable opinion of the Republican Party, with 54 percent viewing the GOP negatively,” the lowest tracking in 25 years.

This comes on the heels of the Washington Post saying only 20% of respondents self-identified as Republicans (a 26 year low.) The GOP has become a regional party (only strong in the deep South, and in terrible shape in the Northeast.) In our Daily Kos Research 2000 poll, Obama’s favorability was 27% in the South and 67% in the rest of the country. Sooner or later, even Beltway pundits will be forced to recognize and deal with the collapse nationally of the GOP, even as they write about a 2010 wave election that has strong potential but may not materialize.

As I and others have written, this is a good time to be an independent, and Democratic weakness doesn’t always translate into Republican strength. All of that is the end result of a disastrous ‘just say no’ philosophy led by Washington Republicans that has left the public with little alternative on policy. The message that the public has gotten about Republicans is that they prefer to rail against government than to actually govern, which based on the last 8-10 years of experience they don’t do very well. It’s going to take a scandal-free successful Republican executive somewhere to change that perception, although such figures are in short supply right now. In the meantime, no one wants to be a Republican while conservative and feisty independents are looking for a new home.

Greg, you are absolutely right: If Republican's "just say no," then they will lose elections. But when Republicans run on specific policies -- based on low taxes, fiscal conservatism, and free enterprise -- they will win. Case in point is Bob McDonnell's campaign for Governor of Viriginia, in which he has called for "keeping taxes, litigation, and regulation low" while outlining specific plans on transportation and job creation. By contrast, McDonnell's Demcratic opponent Creigh Deeds, who trails in the polls, has run an issues free campaign focused more on negative attacks.

A Bob McDonnell victory in "purple" Virginia in November could be a harbinger of a Republican wave in 2010, and the first tangible evidence that the country is rejecting President Obama's big government approach to health care, climate change and other issues. Recall back in 1993, George Allen, then a back bench Congressman, erased a 29-point lead in public opinion polls against Attorney General Mary Sue Terry to win the gubernatorial race in Virginia. Allen ran on a "commonsense conservative" platform to reform welfare, abolish parole, improve education, and promote economic development in the Commonwealth.

Bob McDonnell's campaign has provided an unbelievable jolt of energy to Republicans across the nation. If McDonnell wins on election day, look for Republicans to emulate his successful formula in gubernatorial and Congressional races in 2010.

Iran Away: The White House got a hard lesson in soft power. When Iran looked like it was going to sign a nuclear agreement earlier this week it was high fives all around. Big mistake for two reasons. First, if they signed it would have not been much of a non-proliferation success. It was not a step that would have limited potential for a weapons program development.

Second, they didn't sign making the US much-a-do about nothing look pretty foolish. When negotiating is the strategy all the initiative lies with the party being negotiated with. Iran used that initiative to just play the US. In the future if Iran elects to bargain at all they will demand a higher price. If they sign, they'll just cheat if the agreement gets in the way of what they want. All the administration can do is go polish its Nobel Prize.

It's great to see the "Return of the Public Option," just in time to be a Halloween horror story for right-wingers everywhere. The reason that the public option keeps coming back is that it is good policy. If we want quality health care at an affordable price, then we need to eliminate waste in the health care system and our private insurance system is little more than waste dressed up in suit and ties. For this reason, those who have the goal of providing quality health care for everyone, as opposed to protecting the profits of the insurance industry or handing President Obama a political defeat, will insist on the public option. The return of the public option is a triumph of good policy over corruption.

Lee (MMBJack) McCarty (guest)
NV:

Again Dean Baker has zeroed in on the Media, which I agree with completely. It is clear that the 5 media outlets backing "Fox News on principle of non-interference with the Press is a sorry day for America. That a purely political branch(?) of a political party gets there way when in fact Fox IS the Republican Party today - and that they should not only be allowed but encouraged by these others is outrageous. How can a news system in America - when one of the competitors not only is primarily an entertainment not a serious "news channel", bad enough (entertainment is easier to sell than the Health Plan of a seriously dedicated President to solve real problems in our society) an entertainment channel but actually the just plain solid rock Republican Party who at Fox has a 24 hours a day 7 days a week free AD space. At Alternet.org on "Media &Technology - on October 13Th they said: "In recent years the RNC used to use Fox news to help amplify the partisan raids that national Republicans launched against Democrats" then they go with "now its within Fox News that the partisan witch hunts are plotted and launched and its the RNC that plays catch up to Glenn Beck and company".They got it right before the Obama vs. Murdoch.

Peter Kust (guest)
TX:

Regarding Jack Balkin's commentary about the "new" partisan press entities....anyone who seriously thinks the New York Times has NOT been partisan over the years has likely not been paying attention. Walter Cronkite and Dan Rather have been famously partisan--Cronkite in particular, with his vocal and none too subtle opposition to Vietnam. Ed Murrow took down McCarthy. News organizations have always interpreted events, spun events, going well beyond mere factual recitation of events. Newspapers have won Pulitzers for their interpretations--but interpretation is by definition not "objective". What we are seeing is not a change in the style of reporting but an increasing intensity of hyperbole driven by an increasingly compressed news cycle; whereas papers used to have days to assemble a story, cable news now gives them mere minutes.

Nat Weiner (guest)
NY:

A recent entry by education wonk Diane Ravitch assails New York City Mayor Michael Bloomberg for singlehandedly destroying democracy and voter choice in New York City. Ms. Ravitch is far, far off the mark. She hates the player and not the game and blames the wrong person.
I cannot click a mouse or turn on a radio or television without seeing or hearing a Bloomberg advertisement. I don't find it the slightest bit offensive, because Bloomberg has the right to spend (waste) his own money as he chooses. I'm not impressed. It will not influence my decision an iota. I was almost certain I was going to vote for Thompson, but I may vote for Bloomberg now because of a very positive recent experience with a formerly intractable city bureaucracy that Bloomberg has streamlined considerably.
Bloomberg was entitled to overturn term limits. I don't blame him or the city council. I blame the rules that allowed this to happen. I blame the system that allows pork to be allocated by those in power.
I blame the 80% of the registered voters that did not vote in the primaries. They care more about the Yankees than their city government. They can probably tell you Jeter's batting average but not their own election district.

Chris Sells (guest)
AL:

This morning I was researching past Time magazine covers from Jan. 1970 to Dec. 1985. Just chose the time period for a rough 30 years ago for a comparison of today and how issues/subjects may or may not have changed. Over all it was interesting how little have changed in an overall, nonspecific mentality. To illustrate I will choose Time covers as example. Mar 1972 Is America Going Broke; (Today $11 Trillion plus debt) June 1975 Can Capitalism Survive (we hear everyday some story on the assault of capitalism) January 1976 China: Friend or Foe ( not a foe, but can be but we owe tremendous amount of money) Oct 1977 War On Terrorism;(been ongoing since then) Feb 1982 Unemployment: The Biggest Worry; (10% roughly today) July 1982 Iran On The March (Still are on the March) March 1984 That Monster Deficit (Again still large and growing fast) August 1985 AIDS The Growing Threat (H1N1 anyone?) While these are just a few of hundreds of examples. I guess what I am trying to say is do we learn at all or remain in the box of 24 hour newscycle?

John Gill (guest)
SC:

The major problem that I have today is Americans. We are completely disjointed as a nation. What we accept or don't accept as a nation just drives me crazy. The amounts of money that congress is spending. BHO saying we are no longer a christian nation. The appointment of avowed and admitted communist, socialist, and maoist in this administration. The takeover of GM and Chrysler. Czars that are appointed and not elected that are running our country. Czars saying how much a person can make. Universal healthcare that may or may not be constitutional. So on and so on.
As the nation that we were founded as, Americans are just sitting still. Not having the courage to take a stand for our nation. Not for the politics of our party or ethnic group but standing for what is right for our country. For example,members of congress that are native born and hispanic that push for amnesty for illegals. I can understand wanting to help members of same ethnic group. However, I don't understand the thinking by allowing those that broke our laws to get here, use our services,and take jobs from Americans citizens of all ethnic backgrounds is just plain ignorant. All Americans should just use common sense and do it right.

Edward Johnson (guest)
NJ:

In this healthcare debate has anyone noticed the 800 lb gorilla in the room?Can't miss it.It is called retirees with earned benefits.I know the term benefits has become a dirty word of late,but those of us not yet 65 and who retired in our 50's need ouur benefits and,oh my gosh,we like them.
I keep hearing how if we like our benefits we can keep them.
I worked for Verzion comany for 30 years before retiring in 2000
at the age of 50.I was a lineman and had and still have,my benefits bargained for by Local 827 IBEW here in NJ.Can someone answer me what would prevent this company from dumping retiree benefits to go into an exchange or something else which i would now have to start paying for whereas i do not pay for them now?
Yes i know there is a section in the bill that says comapanies that take benefits away will not get a tax break.So we are to hang our hat on that and HOPE they don't drop us?
All we want is what we earned not a bailout.
Ed Johnson
Chairman
Local 827 IBEW and Passaic CLC
Retirees committees

Lee (MMBJack) McCarty (guest)
NV:

It is a great analysis by Maggie Mahar concerning Public Option in some form as the ONLY way to reduce health care costs and at the same time cover many millions more people for those who cannot afford health care for their families or themselves. I must also commend the gentleman from Cato Mr. Michael F. Cannon who does indeed raise a valid issue on licensing made national instead of state by state licensing of health care professionals - as some contribution to the general problem of costs in health care and for other valid reasons. It is like reducing costs by reducing payments to the injured through limiting awards for malpractice, some good but not likely to be a major issue or saving when the chips are down this year - yea or nay to Public Option Plan, and particularly do we have to settle for the compromised versions that can only cause delay in effectiveness of the final bill or have worse unintended consequences and a potentially very real general discrediting of the Obama Administration as the worst consequence for our President if he does not forcefully come down on the side of the strongest not the weakest plan???. I really see Dean Baker as the real winner for the best of the day. Media complicity is dead right!!!

Lee (MMBJack) McCarty (guest)
NV:

James Carafano caught looking through the glass darkly today. So as the President gets the ball rolling to begin to control Iran's ambitions - if they aren't doing a Saddam Hussein act of pretending are a threat in the middle east at the time - their actions saying yes we have them (WMD) and bluffing us to sucker into a disastrous war - not to excuse the stupidity behind going to war with them instead of clamping down with an expanded no-fly- zone if needed to get tough for some real cause. Now we have and will suffer in the world - and at home far into a diminished future the people behind Mr.Carafano who advocate as American bedrock policy - endless war and an economy based on the Military-Industrial-Oil Complex. Those who try (look at Mr. boogeyman Cheney shooting from the hip and firing to the rear his other automatic slung over his left shoulder spraying gunfire and explosions toward forgotten wars and enemies who have in the presence of a real leader in the world guiding America who has modified or changed their directions. Oh, does that hurt, how they hate this man who has better ideas and the Intelligence and heart to bring reality into our countries future and our whole world - remember who won the Nobel Peace Prize?

Andrea Hitt (guest)
CT:

the profit motive in health insurance has never been a factor in reducing cost - it has been a factor in reducing access to care and lowering provider payments - the profit motive has not even been good for shareholders - with the top 25 executives skimming off the 20% of revenue, no one else is well-served -

R. Alan Smith (guest)
CA:

Candidate Obama promised to "have all the [healthcare] negotiations around a big table ... [where everybody gets] a seat at the table .... [and] we'll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies." Can somebody help me out? I only get 100 channels on my basic cable and I haven't been able to find these negotiations on C-SPAN or anywhere else. Does anyone know what channel they are on? Is it pay-per-view? Or pay-to-play? - R. ALAN SMITH, Momentum Strategist and Executive Coach for Political Leaders and Senior Executives.

Linda Neely (guest)
FL:

I reside in Florida, we have an unprecedented opportunity to participate in the state run housing insurance program. No one wants to; the rates are exorbitant. If your insurable, you get your coverage with one of the PRIVATE companies. I requested my friends as a lark to get quotes for their home owners and the results were well I would throw up if that was my only choice! Friend A $225,000 coverage all bells and whistles is paying $1232. a year (prior to Andrew $229.00) Citizens (state insurer) $3979.00. Friend B $425,000 private, state run $6800. There were no savings but lots of increase for everyone that called for a quote. Want to remind everyone that the private insurers are also tacking onto the current premiums their losses in the MORTGAGE and FINANCIAL sector that they are in. Why when the government runs a FLOOD LOSS program (especially after Katrina) why isn't every household forced to take that insurance?_So far no one has been able to logically show where we are, where we would be going to and how much the expense to us would be. Therefore NO should be the answer. Also no one in Congress or the White House has promised to take the same insurance! Then I respectfully decline also (they must know something).

Paul Metsa (guest)
MN:

Cesar Conda's description of George Allen winning the Virginia Gubernatorial campaign as a "commonsense conservative" is interesting. The fact that there seems to be so few of them left may be one of the reasons why the GOP seems to be in some sort of free fall. My father is an Independent, my mother was a Republican, and I am life long Wellstonian liberal, who has also voted for Republican Arne Carlson (former Governor of MN) who at one time advocated the legalization of marijuana, Jesse Ventura (whose line "the government should be invisible" won my vote), Green Party candidates and write ins. Political discourse has become so toxic, and at times so juvenile, I fear we are losing an entire younger generation due to lack of respectful and reasonable discussion of the issues. In terms of commonsense (as opposed to commonnonsense) I always loved Barry Goldwater's line about gays in the military when he said, "you don't have to be straight, you just have to shoot straight." Respectfully, Paul Metsa (musician) Mpls. MN

Karl Knapstein (guest)
CO:

I am trying to write something positive....I can not seem to find anything and I am an optimist. Here are some predictions with wishfull endings. 1) This time next year the news of the largest Ponzi scheme in the history of modern times, Life Insurance, will "break" and after considerable debate and bribery by the industry, Congress and the President will bail out the Consumer instead of the Corporations. This will create a boom in personal consumption and save Obama's Presidency. 2) This time next year a smart cost/benifit report will show the true waste of resourses the H1N1 "emergency" was. This stark set of facts will open the debate as to the true cause of our young people's immunity problems and and bring back breast milk as we stop injecting our meat with anti-biotics and feeding our children pills for every sniffle. (2) will offset (1), sorry Barack. 3) Spring time will bring the "news" of the massive mining claims the Chinese hold in Afgahnistan and our adventure is really a Quid Pro Quo with a large creditor to keep my underware and socks at the $1.00 per pair level into the forseeable future. Now there is some good news!

Josh Blumenthal (guest)
NY:

re Dean Baker on "Return of the Public Option." Setting aside all the other pros and cons, are we to believe the Federal government will actually reduce waste? Has there ever been a time when a bureaucracy has reduced its own size and cut back waste? We have a much better chance of reducing waste if there is an incentive to do so, such as a profit motive.

David Douglas (guest)
NY:

Obama may have to compromise and, perhaps flip-flop, to make meaningful progress on the agenda. For instance, he may have to offer malpractice reform (to reduce defensive medicine) to get some to sign on to health care. He may have to tax carbon (vs. cap & trade) and add nuclear to get energy & climate change. He may have to wind down Afghanistan if the Europeans do not add troops to reduce our long term deficit and raise the value of the dollar. The initiatives are interdependent. We can not do everything.

Jonathan Wolfman (guest)
MD:

AS IF WE CAN'T GET MORE & BETTER BANK LEADERS IF THEY TAKE THEIR BALL AND GO HOME---Here's a note to those yet angry about government's restricting pay to some bank leaders who took and haven't yet repaid TARP (Troubled Asset Relief Program) tax money. Nearly every bank, large and small, chooses to be regulated by virtue of its participation in the FDIC which guarantees private deposits to $250,000. No bank is interested in numbers of Americans confusing mattresses with safe deposit boxes again yet that's what would occur were banks unable to guarantee savings. Bank profits, small business lending, among many avenues to economic growth, rest on FDIC guarantees. If banks don't want to accept responsibility for the near speculative grave they've dug us, if they don't want to forward recovery, they only need to say so and relinquish FDIC guarantees. Then they can go into the used mattress business

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